Eating Disorders in Teenage Girls

Adolescent girls have always had a great deal to contend with as they experience their own developmental changes in combination with societal pressures and stressors. Now more than ever, teen girls experience a constant barrage of emotional and social stressors that can lead to increased risk of developing eating disorders.

How Many Teenage Girls Have Eating Disorders?

Eating disorders have long been stereotyped as primarily affecting teenage and young adult women. While this generalization is absolutely inaccurate, there is a grain of truth in that adolescent and young adult women are the population most impacted by eating disorder beliefs and behaviors. In fact, the rate of teen girls that struggle with an eating disorder is more than double that of teen boys, with 3.8% of teen girls affected and 1.5% of teen boys affected [1]. Research has learned that “35-57% of adolescent girls engage in crash dieting, fasting, self-induced vomiting, diet pills, or laxatives [2].” Additional studies indicate that 10 out of every 100 young women will struggle with an eating disorder [3].

These numbers have increased since the COVID-19 pandemic. Calls to the National Eating Disorder Association helpline increased by 40% since March 2020 and 35% of these callers were between the ages of 13 and 17. This is a 30% increase from the number of teens of the same ages that called prior to the pandemic [4].

What Causes Eating Disorders in Teen Girls?

There is no denying that adolescence is a tumultuous time for all. As children develop into teens, they experience uncomfortable and confusing body changes that impact their thoughts, emotions, social understandings, and relationships with their appearance, identity, and physical body. Any number of these biological, psychological, and social factors can contribute to eating disorder development.

To begin, the biology of adolescent development is a challenging time. Teen girls will experience the bodily and emotional changes that come along with puberty including the onset of their menstrual cycle, development of breasts and curves, as well as experiencing increasing sexual thoughts and urges. The confusion this creates in regard to how a teen girl views herself or those around her can be hugely impactful. Many that develop eating disorders regard the beginning of puberty as the “starting point” of their behaviors. The physical changes puberty brings about can make a teen girl feel confused by her own body, distancing the relationship they have with their physical selves and causing feelings of uncertainty and misunderstanding. The lack of understanding comfort one has with their physical body can impact their likelihood of developing an eating disorder.

The physical changes that one experiences during these times can also become mental and emotional associations. For example, some women report that they began to receive uncomfortable male attention when they hit puberty, making them feel unsafe in their bodies and, therefore, viewing a more curvaceous body as uncomfortable and unsafe. Additionally, teen girls might experience social judgment or bullying when they experience pubertal changes and might begin to associate a more curvaceous body with being judged, cast aside, or not belonging.

This lends to the social aspect of eating disorder risk that teens experience. With the advent of social media, diet culture messages are more rampant than ever and easily accessible to teens. This means that children and teens are constantly inundated with messages regarding what one “should” look like, what makes a person “desirable,” and what appearance is “worthy” or “valuable” socially. Research has long indicated that media portrayals impact teenage girl’s self-view and feelings of worthiness as well as the relationship they have with their bodies and appearance. One study learned that “girls who want to look like TV or movie stars were twice as likely to be concerned about their weight, to be constant dieters, or to engage in purging behavior [5].” Additionally, “TV exposure significantly predicted disordered eating a year later for girls” in another survey [5]. The messages spouted by advertisements, influencers, and celebrities become internalized beliefs about what makes an individual “enough.” For teenage girls experiencing the uncertain chaos of puberty, all they are looking for is to belong and feel they are “enough” despite the changes they are experiencing and advertisements and media become the guiding post they look to.

Media messages about appearance, weight, food, and worth are more likely to become internalized if the familial messages about eating, the body, and exercise are similar. The way a teenager’s support system, teachers, coaches, etc. talk about these subjects can either make them more or less vulnerable to eating disorder development.

A final addition to consider in the causes of eating disorders in teenage girls is the current social and political atmosphere. Adolescents are experiencing severe daily stressors that did not exist 5 years ago such as increased political unrest, mass shootings, and the COVID-19 pandemic. These stressors can increase a teengaer’s risk for developing any mental health disorder but particularly mood and anxiety disorders, the presence of which are associated with increased likelihood of eating disorder development. One study found that “among teenagers who sought health information online between September and November of 2020, searches on fitness and exercise information came second only to searches for content related to Covid-19 — and ahead of searches on anxiety, stress and depression [4].”

Related Reading

What are the Signs of Eating Disorders in Teenage Girls?

Early intervention is key to increasing the likelihood of recovery for an adolescent girl struggling with an eating disorder. Recognizing the warning signs can make a big difference in longevity of the disorder and future recovery. If you observe the following behaviors in an adolescent girl in your life, it is important to ask more questions and seek out support.

Signs of Bulimia in Teen Girls

Bulimia Nervosa is an eating disorder characterized by binge-eating behaviors followed by compensatory behaviors such as purging, laxative use, or excessive/compulsive exercise to compensate for food consumed. The following might indicate someone is struggling with bulimia:

Extreme weight gain/loss in a short period of time.
Expressing shame or guilt around eating.
Dry/yellowing skin/hair/nails.
Calluses or scrapes on the top of knuckles from using fingers to cause purging.
Frequently going to the bathroom during or immediately after meals.
Distress over body shape/weight/size.
Speaking with a negative body image.
Increased irritability or short temper.
Increased depressive symptoms and suicidal ideation or self-harming behaviors.
Withdrawal from family and friends, particularly in situations related to food or during/after meals.
Uncomfortable eating food around others.
Buying/hoarding diuretics/laxatives.
Hiding food.
Drinking excessive amounts of water.
Exercising despite injury or inclement weather.

Anorexia Warning Signs in Teenage Girls

Anorexia nervosa is an eating disorder that involves an individual engaging in severe restriction of food consumption in an effort to alter their body. Below are warning signs of this disorder:

Reporting an intense fear of weight gain or becoming fat.
Ritualistic eating patterns such as small/large bites, pushing food around, eating in groups, avoiding certain foods, holding food in cheeks, etc.
Emphasis on body weight, size, shape, and appearance that causes apparent distress.
Hyperfixation food, including nutritional content, bodily impact, and
Rigid food rules.
Distorted body image.
Refusing to eat or be seen eating by others and avoiding eating in social situations.
A pattern of declining to eat, possibly stating that they have “already eaten” and/or “aren’t hungry.”
Mood swings and increased emotion dysregulation.
Difficulty thinking clearly and focusing.
Fine hair growth on arms/upper back (known as lanugo).
Loss or irregularity in the menstrual cycle.
Reporting constantly feeling cold as the body struggles to regulate temperature when malnourished.

Eating Disorder Treatment Centers for Teen Girls

Receiving the appropriate level and type of care for eating disorder behaviors can help a teen girl work toward long-term recovery. Not all treatment centers treat adolescents or are aware of the best practices in treating adolescents with eating disorders, therefore, it is important to ask questions of potential treatment centers.

One important question is obviously the age-range of patients that are treated there. Most treatment centers will treat adolescents separately from adults age 18+. Even so, asking is important as it is not a requirement to treat these ages separately, therefore, it is not a guarantee. While there is a lot that a 15-year-old could learn from a 60-year old in eating disorder treatment, studies do show better outcomes when teen girls are treated amongst other teen girls.

Further, ask questions regarding the types of treatment used. Adolescents with eating disorders have shown to benefit uniquely from Family-Based Therapy, therefore, it is important that this is a part of a teen’s treatment. This treatment can be combined with other theoretical viewpoints and places an emphasis on the role the family will play in supporting the teen’s recovery process. It provides education and practice in effective communication for the entire family, not just the identified patient.

Long-term recovery is possible for teen girls struggling with an eating disorder. The aspects that make this most likely include family-based treatment, early intervention, and a focus on rewriting internalized societal beliefs about food, the body, weight, appearance, and worth.

Citations

[1] Unknown (2021). Eating disorders. National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/statistics/eating-disorders#part_2573.

[2] Boutelle, K., Neumark-Sztainer, D., Story, M., & Resnick, M. (2002). Weight control behaviors among obese, overweight, and nonoverweight adolescents. Journal of Pediatric Psychology, 27(6), 531–540.

[3] Unknown (2018). Eating disorders in teens. American Academy of Child and Adolescent Psychiatry. Retrieved from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Teenagers-With-Eating-Disorders-002.aspx.

[4] Damour, L. (2021). Eating disorders in teens have ‘exploded’ in the pandemic. The New York Times. Retrieved from https://www.nytimes.com/2021/04/28/well/family/teens-eating-disorders.html.

[5] Strasburger, V. C., Jordan, A. B., Donnerstein, E. (2012). Children, adolescents, and the media: health effects. Pediatric Clinics of North America, 59.

Author: Margot Rittenhouse, MS, LPC, NCC
Page Last Reviewed and Updated by Jacquelyn Ekern, MS, LPC 3.1.2022